The Impact of COVID-19 on Stroke Care and Outcomes

Bill Sanders was having lunch with his wife Linda one day when he began to have difficulty eating. Linda made a joke, but when her husband’s left arm fell to his side, she knew they needed help—Bill was having a stroke. Fortunately, the couple was already at the University of Michigan Frankel Cardiovascular Center where they had been visiting Bill’s brother. Doctors rushed Bill into emergency care, where they treated his ischemic stroke with medication to dissolve the clot in his brain. He later underwent a thrombectomy.

Bill made a full recovery from his stroke because he received medical care so quickly. Both of the treatments he received must be administered within hours after the onset of stroke symptoms in order to be effective. The sooner they’re administered, the more likely a patient will have a full recovery.

On average, a stroke occurs every 40 seconds in the U.S. and someone dies of a stroke every four minutes, according to the American Stroke Association. Strokes kill more than 137,000 people, that amounts to one in every 18 deaths each year. It’s the fifth leading cause of death in the U.S. and a leading cause of disability.

Most strokes are treatable, but time is of the essence. When a person’s brain is deprived of blood and oxygen, brain cells begin to die within minutes. The sooner a patient receives emergency medical treatment, the less chance they’ll suffer major brain damage and other complications.

COVID-19’s Impact on Outcomes

Despite the emergency nature of a stroke, studies have shown that stroke treatment declined significantly during the height of COVID-19 pandemic. One study, which examined cerebrovascular-specific national and state-wide mortality rates for 40 states and New York City, found that excess cerebrovascular deaths increased in the early weeks of the pandemic, rising as high as 7.8% by mid-April 2020.

The study also showed that those deaths were associated with fewer stroke-related EMS calls nationally and mobility at the state level. The study concluded that a 10% increase in time spent at home was associated with a 4.3% increase in stroke deaths.

Another study of hospital admissions at five large academic hospitals with comprehensive stroke centers in Boston, New York, Providence and Seattle, published in Stroke and Vascular Neurology, showed a 31% decline in hospital admissions for stroke/ transient ischemic attack during March 23, 2020 to April 19, 2020, compared to the corresponding weeks in 2019. The hospitals that were able to provide stroke alert data showed a 46% decline during the same period.

COVID-19’s Impact on Care

The key to stroke treatment is FAST. It’s an acronym that stands for face drooping, arm weakness, speech difficulty and time to call 911. If someone if having one of the first three symptoms, it’s a symptom of a stroke and it’s imperative that the patient receive emergency medical treatment.

So why did patients suffering stroke symptoms fail to seek medical treatment during the COVID-19 pandemic? It could be due to a number of factors, including fear of contracting COVID-19, outpatient clinics canceling in-person appointments, lack of social interaction leading to underreporting of symptoms, and even large numbers of people leaving large cities.

It could also be that patients only sought treatment as their symptoms got worse, which could help explain the rise in baseline stroke severity from 7 to 10 in late March 2019 to late March 2020, using the National Institutes of Health Stroke Scale.

Awareness Campaign

The decline in those seeking treatment for stroke prompted organizations like the American Heart Association and American Stroke Association to reiterate the importance of emergency medical care even in the midst of a pandemic.

“Although COVID-19 has changed the world, it hasn’t changed the fact that hospitals are the safest place to be if there’s a heart attack, stroke or other medical emergency,” the organization wrote on its website.

“Delaying the 911 call that gets you to the hospital can be dangerous — even deadly…Fast care is the key to survival. Minutes matter. People with blocked arteries or clots causing heart attacks or strokes need care quickly. The difference between life and death can be measured in minutes. With so little time to work with, and the extra time needed to ensure coronavirus safety measures, calling 911 quickly is more important than ever.”